Frequently Asked Questions

Frequently Asked Questions

If you have coding questions regarding Medicare Risk Adjustment, HCC codes or general coding and documentation questions please ask a coder at HCCacademy@caremore.com. They will be answered in the order received and then posted in the FAQ.

Questions:

Q. If a patient has multiple complications due to diabetes; do I have to code all of the E11.XX codes for each complication? Example, patient has Peripheral Neuropathy and CKD both due to diabetes, can I just code E11.22 for diabetes with renal manifestations.

A. No, you must code all of the appropriate E11.XXcodes. If a patient has Peripheral Neuropathy due to diabetes the codes would be E11.40 Diabetes with Neurological Manifestations. For the CKD due to Diabetes you would code E11.22 Diabetes with Chronic Kidney Disease and N18.9 for the unspecified CKD. The diagnosis of Peripheral Neuropathy due to Diabetes and CKD due to Diabetes would require 3 ICD- 10 codes.

Q. How do I code Diabetes with other complications?

A. When coding Diabetes with other manifestations, coding guidelines require two ICD-10 codes to indicate the entire diagnosis. You would need E11.69 Diabetes with other specified complication and a code to specify what the other complication is. In your documentation, it is advised that you clearly state the relationship of the complication with words such as “diabetic,” “due to diabetes,” and/or “secondary to diabetes.”

Each time this code is chosen as the diagnosis a second ("buddy") ICD-10 code MUST be assigned as well.

The following are some examples of the "buddy" code. This is not an all-inclusive list
• E11.69 & I10 Hypertension
• E11.69 & E78.5 Hyperlipidemia

Q. I am a podiatrist and if I document Neuropathy and Diabetes, would that be coded E11.42?

A. No, you cannot assign E11.42 because your documentation states “Neuropathy”. You would however be able to assign E11.40 Diabetes with diabetic neuropathy unspecified. ICD-10 guidelines assume a relationship between diabetes and certain manifestations with neuropathy being one of them.

Q. What is the code for CAD?

A. Coding for CAD in ICD-10 depends on whether there is documentation of the patient having a previous CABG and/ or whether the patient is documented as having angina as well. These combination codes assume the relationship between atherosclerosis and thus a separate code for angina is not necessary.

CAD of CABG without angina is I25.810
CAD of CABG with unspecified angina is I25.709
CAD without angina is I25.10
CAD with unspecified angina is I25.119

Q. How do I code a CVA with weakness?

A. The code for CVA with weakness would be I69.398. If however you feel the patient has weakness of the entire left or right side of the body and meets criteria for CVA with Hemiparesis, the code for that is I69.259 as long as the condition is properly documented.

Q. What is the best way to document for Deep Vein Thrombosis and how do I code for that?

A. When documenting DVT, it is important to specify if it is Acute or Chronic.

Following coding guidelines, if you document "DVT", it is assumed to be an acute condition and the code is I82.409 (Acute venous embolism and thrombosis of unspecified deep vessels of unspecified lower extremity).

If the patient is on anticoagulant therapy then the appropriate documentation should be "Chronic DVT on Coumadin" or "Chronic DVT on an anticoagulant" and the code is I82.509 (Chronic venous embolism and thrombosis of unspecified deep vessels of unspecified lower extremity) and Z79.01 (Long term (current) use of anticoagulants).

If the DVT is NOT considered acute and the patient is NOT on anticoagulant therapy, the appropriate documentation should be "H/O DVT" and the code is Z68.718 (Personal history of venous thrombosis and embolism).

Q. How do I code for ulcers?

A. There are two types of ulcers, non-pressure ulcer or pressure ulcer also known as decubitus.

Pressure ulcers have combination codes in ICD-10 and are assigned codes based on location, laterality, and stage. Pressure ulcers of unspecified site have codes in the range of L89.90-L89.95.

L89.95 Pressure ulcer, unstageable of unspecified side is only assigned if the ulcer is covered by eschar, has been treated with skin or other graft, or is documented as deep tissue injury but not documented as due to trauma.

L89.90 Pressure ulcer, unspecified site, unspecified stage is assigned when there isn't any stage or site specified.

Non-pressure ulcers of the lower leg require only one combination code for the site and laterality. The code range is L97.901-L97.929.

Q. How do I code CKD and Hypertension?

A. When a patient has a diagnosis of CKD and Hypertension; this is an assumed cause and effect relationship per coding guidelines. It is considered Hypertensive Chronic Kidney Disease.

The code for CKD would be N18.X (X = stage) and the Hypertension becomes I13.0 Hypertensive Chronic Kidney Disease when the CKD is stage 1-4 or 9. For CKD stage 5 or 6 the Hypertension code is I13.2.

You would not assign code I10 Hypertension Unspecified, when the patient has a diagnosis of CKD as well.

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